Fibromyalgia, what it is and how to deal with it: the hopes of research

Sometimes there are diseases that are not recognized in time, and which even make those who suffer from them appear to be “imaginary sick”. In the case of fibromyalgiaUnfortunately, it still happens that pain is not correctly identified and those who suffer from the condition feel misinterpreted in some way.

So, at least the May 12th, let's reflect on this pathology. The date is not random because he was born on May 12, 1820 Florence Nightingale, considered the founder of modern nursing science and one of the most influential British women of the Victorian Age. The woman died in 1910, she most likely suffered from fibromyalgia and despite this she never shied away from her work. Like many women today. And with great effort. It is estimated that the 2-4% of the general population is affectedof which 80% are women, with an average age between 30 and 50 years.

What fibromyalgia is and what it is not

It is a chronic painful syndrome whose cause is unknown, which manifests itself with problems affecting some specific sites: among the disorders there may also be weaknessa sleep which does not appear restful, even problems like the irritable colon.
In fact, the clinical picture goes beyond pain: we are faced with one of the most common causes of chronic widespread pain and is often characterized by the co-presence of symptoms such as tiredness, difficulty concentrating, asthenia, sleep disorders, but also anxiety, depression and headache.

There is a primary form of the disease, not associated with other pathologies, and a secondary form that occurs in patients who already have it other rheumatological diseases (such as Sjogren's Syndrome or other connective tissue diseases, rheumatoid arthritis, spondyloarthritis or psoriatic arthritis).
The pathology appears strongly related to physical or psychological trauma which can trigger it in a predisposed individual. There voltage can play an important role in determining the picture, as well as depression and anxiety. It should also be remembered that over 30 percent of rheumatic pathologies are associated with fibromyalgia and almost two out of three people who suffer from this condition have other chronic diseases.

There diagnosis is essential to prevent sufferers from locking themselves away and “self-managing” their pain. Last general aspect: it should absolutely not be considered a psychosomatic pathology. There are no psychological differences between those suffering from fibromyalgia and those with other rheumatic diseases, such as rheumatoid arthritis. The emotional state is therefore a “consequence” of the disease and should not be considered as a cause.

What is the pain of fibromyalgia like

There is still much to be done to free fibromyalgia from its aura of mystery and… diagnostic difficulties that characterizes the pathology. The most common symptoms are sometimes confused with those of other pathologies and can be numerous: widespread pain, constant feeling of tiredness, sleep disturbances, tingling, spasms and muscle contractions, weakness of the limbs, palpitations and intestinal disorders. AND it is difficult for the patient to understand who to turn toalso because it is sometimes little considered.

Often those affected by fibromyalgia he doesn't know which specialist to turn toalso because of the plurality of symptoms and in the absence of alterations in laboratory tests he can be seen as a hypochondriac.
Chronic pain, in any case, is the most classic sign of the pathology. And it must be recognized, given that there are many causes that give rise to it: inflammatory, as in the case of arthritis, arthrosis or low back pain, neuropathic, as happens in carpal tunnel syndrome or a herniated disc that compresses a root nervous system, or it can have a mixed genesis, as happens for example when several problems are associated, not just rheumatological ones. And that's not all, there is also the nociplastic one, which has aalteration of nociception (the neurobiological systems involved in the perception of pain). Now, this is the typical pain of fibromyalgia.

How to deal with fibromyalgia

Treatments must be studied on a case-by-case basis. In general terms, integrated pathology treatment is based on four pillars: patient education, fitness (aerobic activity, Thai-chi, yoga, pilates, postural gymnastics, swimming, etc.), psychotherapy And pharmacotherapy.

Currently no drug is indicated for use in fibromyalgia but in clinical practice they are used supplements, muscle relaxant drugs, anti depressants and anticonvulsants, depending on the prevailing symptoms. An approach that is as personalized and gradual as possible, based on objectives shared with the patient, is essential.

It must be said that these approaches are also linked to the fact that a lot There is still much to be known about the causes of the pathology. It is believed that there is a combination of genetic predisposition (family history) with stressful life events (traumas, surgeries, illnesses, etc.); Furthermore, at the level of the central nervous system, numerous alterations of neurotransmitters or hormonal substances have been documented which determine the altered perception of pain.

The difficult diagnosis of fibromyalgia and the hopes of research

Unfortunately there are no specific instrumental tests for the diagnosis, which occurs by excluding relevant rheumatic pathologies. Although it is not a degenerative disease, chronic pain and stiffness caused by fibromyalgia are pervasive and persistent: the symptoms do not increase over time but are fluctuating and vary in relation to numerous external factors that are capable of causing them to worsen. This is the case for example of climatic factors (the pain and stiffness are worse in this season and in periods of high humidity), gods hormonal factors (premenstrual period, thyroid dysfunction), dei psychological factors and of theaging.

However, what matters in arriving at the diagnosis is finding a certain trace. That is, a biomarker able to diagnose fibromyalgia and represent a possible target to be hit with advanced drugs already available for other pathologies, expanding the tools available to treat this syndrome. The research of Annunziata Capacci, head of the Fibromyalgia Clinic at the Agostino Gemelli University Hospital in Rome, at the Rheumatology Unit directed by Maria Antonietta D'Agostino, is focusing on this aspect. The study is conducted on behalf of FIRA, the Italian Foundation for Research in Rheumatology.

Do fibromyalgia and migraines travel together?

The diagnosis is made complex by the extreme variability of the symptoms and the absence of biomarkers and often it arrives late, years after the onset of symptoms.

“An urgent medical need for fibromyalgia is the identification of biomarkers to define the disease and characterize its phenotype and severity. Clinically, fibromyalgia has many characteristics of central sensitization and the high prevalence of fibromyalgia in association with migraine suggests that they may share a common cause – explains the expert. In particular, we hypothesized that fibromyalgia patients may have elevated levels of CGRP, the peptide that has long been believed to play a fundamental role in the pathophysiology of migraine. Consequently, in our study we will evaluate whether in patients suffering from fibromyalgia and migraine, treated for the latter according to neurological indications with anti-CGRP drugs, the therapy also brings benefits for fibromyalgia. If our hypothesis were confirmed it would pave the way for new therapeutic possibilities. Drugs already approved for migraine could also be used for the treatment of fibromyalgia, expanding the tools available to improve patients' quality of life.”